1. Nutritional Assessment

2. Over-nutrition (Obesity and over weight)
Associated problems
Heart disease
Cancer
Hypertension
Diabetes
Joint disease
Surgical complications
Venous thrombosis

3. Under-nutrition (malnourished)
Problems associated
Poor wound healing
Sepsis
Abcess formation
Other infections such as pneumonia

4. Why is the assessment of nutritional risk important?
Potential to reduce the severity of the disease
Potential for shortened recovery time
Ultimately leads to better patient outcomes and reduced health care costs

5. Elements of Nutritional Screening & Assessment
Health History
Medical History
Diet History

6. Health History
Weight gain or loss, history of N/V/D, or change in appetite
Menstrual history
Family history - heart disease, etc.
Lifestyle habits - smoking, exercise, eating out, fast food, etc.

7. Medical History
Drugs that may affect appetite
Drug interactions that may affect nutrient absorption, metabolism, or excretion
Supplement use, especially excessive supplementation in the elderly
Inform clients of harmful effects of some supplements in megadoses:
A & D accumulate in the body
B & C may increase risk of kidney stones

8. Diet History Usual food and fluid intake Eating patterns and habits
Type and amount eaten
Eating patterns and habits
# and timing of meals and snacks
setting of meals eaten at home
frequency of meals eaten out
Snacks

9. Diet History Food preferences and restrictions Problems with eating
religious or cultural
food allergies or intolerances
Problems with eating
Chewing or swallowing
Physical limitations-i.e., unable to cut or mash foods
Food buying and preparation

10. Types of Diet History
Diet Recall
Food Record Recall
Food Frequency

11. Diet Recall
Ask client to recall everything eaten on the previous day or on a typical day
Advantages
Easy to administer
Easy for client to participate
Disadvantages
Only assesses one day’s intake
Doesn’t reflect differences-seasons or holidays
Relies on memory

12. Food Record Recall Ask client to record intake over at least 3 days:
Advantages
Takes only a small amt of time for interviewer
More representative of clients diet
Helps them review dietary habits
Disadvantages
Need to be literate
Time consuming for client
Eat better during collection period

13. Food Frequency
Ask client via a questionnaire how often certain foods have been eaten in past 6-months
Advantages
Interviewer not required
Quick to complete
Provides a view of dietary habits over a period of time
Disadvantages
Can’t assess # and timing of meals
May not reflect cultural dietary habits
May have difficulty completing forms

14. Food Guide Pyramid

15. Healthy Diet
The Dietary Guidelines from USDA describe a healthy diet as one that
Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products;
Includes lean meats, poultry, fish, beans, eggs, and nuts; and
Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

16. Anthropometric Measurements
Height and Weight
BMI
Body Composition
Body Proportion

17. Anthropometric Measures
Measure size, weight, and proportions of human body
Clinically significant weight changes
>5% BW over 1 month
>7.5% BW over 3 months
>10% BW over 6 months

18. Height and Weight Weight and height most common measurements
Height-flat, vertical measuring surface, no shoes, stand erect
Weight-minimal clothing, no shoes, empty bags including colostomies, same time each day, coordinate with diuretic dosing.

19. Body Mass Index Assessment of optimal weight for height
< Underweight
Normal
25.0 – Overweight
30 – Obesity
> 40 Extreme Obesity

20. Body Composition Proportion of fat versus muscle mass
Skinfold calipers to measure skinfold thickness
Calipers used most often

21. Body Proportion – Waist to Hip Ratio
Where fat is accumulated on body?
Apple shape - abdominal accumulation
Android obesity
Increased risk for obesity-related diseases and early mortality
Pear shape - hip accumulation
Gynoid obesity

24. Laboratory Measurements
Serum albumin
Decreased protein, poor wound healing, immune system compromised
Nitrogen balance
Index of Protein nutritional status
TLC (total lymphocyte count)
Assess immune system, malnutrition causes decrease TLC, also AIDS

25. Laboratory Measurements
Hgb & Hct
Associated with anemia
Hgb A1C- compliance with Diabetes
Fasting blood glucose
Screening for diabetics or glucose intolerance,
Glucose levels increase when pancreas is not secreting enough insulin or when insulin resistance is present in peripheral tissues
Cholesterol & Triglycerides
Elevated lipid levels, and heart disease risk
High LDL, low HDL

26. Laboratory Measurements
Creatinine-Height Index (CHI)
Estimates amount of skeletal muscle mass
Skin Testing
Immunity function

27. Dietary Deficiencies for Specific Client Populations
Healthy adults & children
Low fiber, fruits & vegies
Vegetarians
Need supplemental Vit B12-only found in animal products
Athletes, active children & adults
Need complex carbohydrates (muscle energy)
Need iron-rich foods to correct anemia

28. Dietary Deficiencies for Specific Client Populations
Pregnant and breast feeding women
Last 2 trimesters-caloric needs increase by 300cal/day
Breast feeding requires 500 additional cal/day
Elderly men & women
Drying of mouth, decreased sense of taste & smell, decreased thirst, may diminish appetite
Obese clients
63% of US population is overweight
25% of children are obese

29. Nutrition and Illness Eating disorders HTN, diabetes, heart disease
8 mil people have either anorexia or bulimia
HTN, diabetes, heart disease
43 mil people, more common in African Americans
Cancer
Increased caloric requirements
Decreased appetite